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Violence Against EMS Provider Reporting Tool

Welcome to the Violence Against EMS Provider Reporting Tool developed by the Center for Leadership, Innovation and Research in EMS in cooperation with the National EMS Management Management Association (NEMSMA). This tool has been created for EMS practitioners to anonymously share violence against EMS provider information by answering a series of questions in an online format. The data collected will be analyzed and possibly used in the development of EMS policies and procedures, as well as for the purpose of training, educating and preventing similar events from occurring in the future. Thank you very much for reporting your violence against EMS provider incident.  The information you  provide will contribute to saving lives in the future. 

 

EDUCATORS AND STUDENTS: If you want to practice submitting simulated events, do not use the form on this page, use our student practice form instead.

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  • Provider Violence EVENT Report

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  • VICTIM INFORMATION

















































  • ASSAILANT INFORMATION













  • GENERAL INFORMATION







Contact Us

Center for Leadership, Innovation and Research in EMS • P.O. Box 2286 • St. Cloud, Minnesota 56302
800-342-7849 or 320-229-3621 • 320.251.8154 (fax) • Contact Us